Aberrant origin of the left anterior descending artery and quadrifurcation of coronary vessels associated with coronary artery disease: evaluation by computed tomographic angiography and coronary angiography.

Coronary artery anomalies occur in approximately 0.2-12.2% of the adult population. Origin of left anterior descending artery and left circumflex artery from the right coronary cusp is relatively rare. The case we present is unique in that all 4 vessels (right coronary, left anterior descending, left circumflex and atrioventricular nodal branch) take off from the right coronary cusp, making a quadrifurcation. In this case, the left main artery is also absent. To our knowledge, there are few published case reports of anomalous origin of left anterior descending artery, but the total absence of a left main artery and quadrifurcation are unique to our case.